Monday, August 13, 2007

Is This How The Flu Pandemic Begins?

Virulent Flu Epidemic Fills Australian Hospitals

UPDATE : ABC News Australia has reported this evening that a 29 year old woman and her five year old child have died from suspected bird flu in Bali in the past week. A two year old girl, from the same small Balinese village, has been hospitalised with bird flu symptoms.

Below is one of the absolute nightmare scenarios for the hundreds of doctors, scientists and medical specialists in Australia who've spent the past three years preparing for an influenza pandemic in Australia :

An Indonesian travels to Bali for holidays, or business. They feel a bit under the weather on the short flight to Bali, but not enough to visit a doctor, or a hospital, when they arrive in Denpasar.

Within days of arriving in Bali, they fall seriously ill, high fever, lungs rapidly filling with fluid. By the time they get to a hospital, it's too late. The next morning, the person is dead. Tests confirm that the person died from the bird flu virus, and the media carries stories about huge numbers of chickens dying from the virus in the dead Indonesian's hometown.

In the three or four days before the person died in Bali, they moved through dense, tourist packed beachside suburbs, like Kuta, coming into contact with people from all over the world. One of those tourists was a young Australian from Queensland.

Before he left for his holiday, the Australian had been feeling terrible, like many of his friends and co-workers, he had been struck down by a particularly virulent influenza virus. Not wanting to cancel his holiday, and miss all the fun, he loaded up on Codrals and made his flight. In Kuta, still feeling rundown and bone sore from the influenza, the Australia walks past the H5N1-infected Indonesian, who sneezes in the Australian's vicinity.

The Australian tourist inhales some of the sneeze cloud of H5N1-dusted moisture from the Indonesian. Inside the Australian's lungs, or in his throat, the H5N1 virus meets Influenza A. They breed, they mutate, they swap genes, becoming an easily transmissible version of the bird flu virus.

On the flight home, after a week's holiday in Bali, the Australian is feeling really, really sick. He just wants to get home and get to bed. He sneezes on the plane, into his hands, then staggers to the toilet, touching seats and surfaces along the way, looking for privacy to give his nose a good blow.

Other passengers heading to Australia breathe in his bird flu-infected sneeze droplets, or touch the same chairs and surfaces that he touched, leaving behind the virulent virus which can now survive outside the human body for hours, perhaps even days.

Other passengers rub their tired eyes, after touching the seats the sick tourist touched, and the bird flu virus infects them, too.

When the plane from Bali arrives back in Sydney, the passengers split up for flights on to Melbourne, Adelaide, Brisbane, the United States, England, Germany. Dozens of people on the flight picked up the H5N1-Influenza A hybrid virus and will be sick, and close to death, within days. But before they are sick enough to require isolation, or treatment with anti-virals, they will each come into vicinity or personal contact with hundreds of people. The now easily transmissible bird flu virus spreads across the world.

Back in Australia, the human bird flu pandemic is already underway. Within 10 days, a few dozen will have died from the virus. Within a month, the fatalities will top a few hundred. Within two months, a few thousand. By the time, the deadly viral spread is called a pandemic, tens of thousands of Australians have become infected, if not hundreds of thousands.

That's the kind of realistic 'what if?' scenarios that helped to shape the planned response by federal and state government and health agencies to potential human bird flu infections in Australia, and what steps would be taken to contain the spread of H5N1, and to disable as much as possible the growth of a bird flu pandemic.

Samples from an Indonesian woman who died on Sunday on the resort island of Bali have tested positive for bird flu after an initial test, officials said on Monday.

A second laboratory test, which is now being conducted, is necessary to confirm the initial findings, Joko Suyono of the health ministry's bird flu centre said.

The woman, 29, from a village in the district of Jembrana in western Bali, was suffering from a high fever before dying of multiple organ failure, said Ken Wirasandi, a doctor at the Sanglah hospital in the Balinese capital Denpasar.

Suyono said there had been sick chickens around the woman's house and many had died suddenly in recent weeks.

"The villagers didn't burn the carcasses. Instead they buried them or fed them to pigs," Suyono added.

Contact with sick fowl is the most common way for humans to contract the H5N1 virus.

The woman had started showing symptoms more than a week ago, but was only admitted to hospital six days later.

Another two adults, both in their 30s and both from Queensland, have died after developing flu-like symptoms.

Queensland's Chief Health Officer Jeannette Young will hold a news conference at 3.30pm.

The deaths follow those of a four-year-old boy and 37-year-old father-of-three Glen Kindness in Queensland in the past two weeks after they developed influenza A.

Premier Peter Beattie said today the Queensland Government would make its stockpile of the anti-viral drug Tamiflu available to ensure everyone who needed the drug would have access to it.

The Premier said he would be asking Prime Minister John Howard to follow Queensland's lead to provide stocks of Tamiflu from the national stockpile to residents of aged homes.

Releasing Tamiflu to cope with an Influenza A epidemic is not unusual, but because the threat of a bird flu pandemic is so real, and so possibly devastating, there is a reluctance to use limited stocks of anti-virals to fight the yearly outbreaks of influenza.

Mr Beattie may be acting with caution, fearing further deaths, or he may be aware of information not yet made public, from which he shaped his decision to dig into the Tamiflu stockpile and to ask the prime minister to do the same.

While the latest deaths of children and people under 40 years old from Influenza A are making headlines, the media has dropped all references to the already high death toll the influenza epidemic has clocked up so far, as this report from July 22, in Sydney's Daily Telegraph details :

AT least 150 elderly Sydneysiders have died from the most serious flu outbreak to hit the city in four years. The victims have all died this month after suffering complications, mainly pneumonia, caused by the influenza A virus, a Health Department report reveals.

Babies and young children have also been hard hit. Hundreds have required specialist treatment in hospitals.

Although the elderly are particularly at risk in winter, he said the full extent of cases was not known as many people did not seek medical treatment for the influenza A virus.

At Sydney Children's Hospital at Randwick, the number of youngsters at the emergency department with viral infections has soared by 200 per cent compared to last year.

Respiratory illnesses have risen by 70 per cent.

Doctors in Sydney held an urgent teleconference with West Australian colleagues last week following the death of a fourth child there.

So severe and prevalent are the cases of influenza A and bronchiolitis that babies such as seriously ill Liam Wolthers had to be placed in an adolescent ward until a bed became available at the Randwick hospital.

What began as a runny nose quickly escalated to breathing difficulties. He was rushed to hospital where he required oxygen for six days.

Dr Adam Jaffe, head of the respiratory department at Sydney Children's Hospital, said there had been a peak in cases of bronchiolitis and viral pneumonias compared to previous years.

In WA, doctors are desperately trying to discover the reasons behind the four child deaths.

The media is now focusing primarily on the deaths of children from Influenza A. Why have they dropped all references to the figure cited above of more than the 150 elderly people who have died in the past few months?